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Get Request For Affidavit Of Member Changes

Er of Local Licenses, Substitution of Names on License, I am requesting the following member changes to the alcoholic beverage license(s) issued to this establishment. Establishment: Business Entity Phone Number: Address: Member Change #1 Present Member being removed Reason for Change Signature of Member being removed New Member (Print Full Name) New Member Address Signature of New Member Date of Change New Member phone Member Change #2 Present Member being removed Reason for Change.

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